BETTY’S HOPE ARCHAEOLOGICAL &
BIOARCHAEOLOGICAL FIELD SCHOOL ANTIGUA, SUMMER 2015
PROGRAM APPLICATION
IMPORTANT DATES:
March 27, 2015
Application and $500 deposit due.
April 3, 2015
Students will be informed via email of their acceptance.
April 17, 2015
Flight confirmation (paper ticket or e-ticket) and photocopy of passport due to
Continuing Education.
May 1, 2015
$3,645 final fee payment due plus $240 for 4 units (optional).
May 4, 2015
Pre-departure online orientation
June 20, 2015
Mandatory study abroad orientation on site in Antigua.
PROGRAM REQUIREMENTS:
Students from all colleges and universities can apply to this program. In order to be eligible to participate in the
program, students must:
• Be in good academic and disciplinary standing.
• Submit a complete application packet by March 27, 2015
• Have a valid passport.
• Assume financial responsibility for program expenses and agree to all terms and conditions to ensure a
safe and effective study abroad experience.
APPLICATION CHECKLIST:
Be sure to complete all sections of this application. Applications will be reviewed by the program faculty in the
order received. You will be notified when your application has been accepted, and program updates and
important communication will be sent to your Chico State email.
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Participant Information Form

Authorization for Release of Information
Financial Statement
Statement of Purpose
Study Abroad Health Statement

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Release of Liability Waiver

$500 non-refundable application deposit
Emergency Contact Information
Foreign Travel Insurance Program
Acknowledgement
Student Code of Conduct Agreement
Photocopy of your Student ID card
Photocopy of your passport. If the copy of
your passport cannot be turned in with
the application, it must be turned in to
Continuing Education by April 17, 2015
Page 1 of 13
REVISED SEPT. 2014
BETTY’S HOPE ARCHAEOLOGICAL &
BIOARCHAEOLOGICAL FIELD SCHOOL ANTIGUA, SUMMER 2015
PARTICIPANT INFORMATION
Name: _______________________________ Chico State ID Number: ______________________________
Home Institution (required for non-Chico State students): __________________________________________
Major: ________________________________ Gender:
 Male
 Female
Address: _________________________________________________________________________________
Home Phone: __________________________ Cell Phone: ________________________________________
Email Address: ____________________________________________________________________________
Class Level:_____________________________ Expected Graduation Date: ___________________________
T-shirt Size:  S  M
 L  XL  XXL
Have you ever been on disciplinary probation? Please check one:
 YES
 NO
If “yes,” please attach a one page letter to this application, describing the infraction, and explaining why you feel this past
infraction is not an indication of your ability or willingness to represent CSU, Chico and the U.S.A. with dignity and pride
while abroad.
I certify that the information given in this application is true and complete and that I have read and understood the program
requirements. I understand that important information pertaining to this program will be sent to me via email, and that it is
my responsibility to read all updates and report any problems with my email account to the Center for Regional &
Continuing Education immediately. I understand that completion of this application is not a guarantee of my acceptance into
this program and that my eligibility to participate in this program will be determined by my application, my disciplinary
history at all universities I have attended (including, but not limited to previous exchange programs I have participated in),
and possibly an interview. By signing below, I consent to a complete review of my history of disciplinary standing. I
understand that I am only eligible for this program if the results of this review indicate that I have a history of good
disciplinary standing and that I meet all of the requirements for the program.
Signature: _________________________________________________ Date: _________________________
Print Name: _______________________________________________________________________________
Page 2 of 13
REVISED SEPT. 2014
BETTY’S HOPE ARCHAEOLOGICAL &
BIOARCHAEOLOGICAL FIELD SCHOOL ANTIGUA, SUMMER 2015
FINANCIAL STATEMENT
The total estimated cost of this participation in this program is approximately $5,685, depending on airfare and
personal spending while traveling.
PROGRAM FEES: $4,145
Program fees include course registration (non-credit option only); lodging and all meals; ground transportation
in Antigua; field trips and related course activities; instruction, supervision at field sites; foreign travel health
insurance; and in-country orientations. Course reader, field notebook and Project T-shirt included.
Enrollment in a credit or non-credit course is required for this program. Please select your course registration:
Credit Program: (for course descriptions, please visit http://rce.csuchico.edu/passport/antigua)
 ANTH 280 (4 units, undergraduate) $240
 ANTH 380 (4 units, undergraduate) $240
 ANTH 480 (4 units, undergraduate) $240
Non-Credit Program:
 RCED 979H (Included in program fee)
PERSONAL EXPENSES (variable; approximately $100-500)
Personal expenses include additional food and incidentals you may wish to purchase while abroad. Most
expenses are already accounted for in the program fees; however, you are encouraged to plan for some
personal expenses for entertainment or shopping by bringing some extra cash and/or a credit card to cover
these expenses. Unexpected and urgent expenses may arise while abroad. Be prepared!
AIRFARE (variable; approximately $800)
You are responsible for airfare to and from Antigua, arriving in Antigua on June 20, 2015 and returning to United
States on July 18, 2015. Fares depend on when you purchase your ticket, your itinerary, and the airline selected.
Please submit a copy of your flight confirmation to Regional and Continuing Education no later than April 17,
2015. Refundable tickets are highly recommended.
VISA
No visa required.
Page 3 of 13
REVISED SEPT. 2014
BETTY’S HOPE ARCHAEOLOGICAL &
BIOARCHAEOLOGICAL FIELD SCHOOL ANTIGUA, SUMMER 2015
PROGRAM FEE PAYMENT SCHEDULE
$500 non-refundable deposit: March 27, 2015
$3,645 balance due plus monies for credits: May 1, 2015
You may pay with Visa/MC, Money Order, Cashier’s Check, or cash at the Center for Continuing Education. If you
are not accepted to the program or the program’s minimum enrollment is not met by April 3, 2015 the deposit
will be refunded to you.
If paying the $500 deposit by check, please make the check payable to the CSU, Chico Research Foundation.
If paying the fee balance by check, please provide two checks:
$240 payable to CSU, Chico
$3,645 payable to the CSU, Chico Research Foundation
I fully understand the costs of participating in this program, and I understand that program fees are non-refundable. I realize
that I am responsible for air fare and personal expenses and that the estimates provided are subject to change due to
fluctuations in the exchange rate, airline rates, and other changes not under the control of CSU, Chico. I understand that if
my expenses exceed my resources, it is my responsibility to explore additional sources to finance the difference. Furthermore,
I understand that it is my responsibility to budget my resources while participating in this program in such a way that I am
able to cover all costs, including but not limited to additional travel, personal needs, and entertainment.
Signature: _________________________________________________ Date: ____________________
Print Name: __________________________________________________________________________
Page 4 of 13
REVISED SEPT. 2014
BETTY’S HOPE ARCHAEOLOGICAL &
BIOARCHAEOLOGICAL FIELD SCHOOL ANTIGUA, SUMMER 2015
STATEMENT OF PURPOSE
Name: ______________________________________________________________________________
Please discuss:
1) What benefits do you anticipate gaining from taking this course in Antigua, rather than a similar course
on campus at Chico State or a course at your home institution?
2) How do you plan to contribute to the success of the program, both as a student and as a cultural
ambassador to Antigua?
Page 5 of 13
REVISED SEPT. 2014
BETTY’S HOPE ARCHAEOLOGICAL &
BIOARCHAEOLOGICAL FIELD SCHOOL ANTIGUA, SUMMER 2015
STUDY ABROAD HEALTH STATEMENT
It is vital for the CSU, Chico to have your current health information on file in case of an emergency. Please
inform Continuing Education or your instructor of any changes in your health prior to and during the program,
including prescription medications. This information will not affect your eligibility to participate in the program
and will remain confidential.
Please answer the following health questions completely and to the best of your knowledge. If you answer YES
to any of the questions, please describe on the space provided or use an additional page if needed.
1. Do you have any dietary restrictions or known food allergies? Describe any.
________________________________________________________________
 Yes
 No
2. Do you have any allergies to medication(s)? List any and describe the reaction.
________________________________________________________________
 Yes
 No
3. Are you taking any medication(s)? List all medications and what each treats.
________________________________________________________________
 Yes
 No
4. Do you have any disability, condition or impairment that might affect
travel or participation in an overseas study program?
________________________________________________________________
 Yes
 No
5. Do you have any disabilities which could affect your adjustment to a new culture
or to the academic program?
________________________________________________________________
 Yes
 No
6. Do you require any other special accommodations (special services)?
________________________________________________________________
 Yes
 No
7. Are you currently undergoing treatment for any reason?
________________________________________________________________
 Yes
 No
8. Have you ever had a major illness such as rheumatic fever or tuberculosis?
________________________________________________________________
 Yes
 No
9. Do you have any other allergies? Please specify.
________________________________________________________________
 Yes
 No
I certify that the information on this statement is correct.
Signature: _________________________________________________ Date: ____________________
Print Name: __________________________________________________________________________
Page 6 of 13
REVISED SEPT. 2014
BETTY’S HOPE ARCHAEOLOGICAL &
BIOARCHAEOLOGICAL FIELD SCHOOL ANTIGUA, SUMMER 2015
EMERGENCY CONTACT & MEDICAL INFORMATION
Participant Name (Last, First): ____________________________________________________________
Emergency Contact
Name: _____________________________________________ Relationship: _____________________
Street Address: _______________________________________________________________________
City, State, Zip, Country: ________________________________________________________________
Phone Numbers:
Home: _____________________________________________________
Work: _____________________________________________________
Cell: _______________________________________________________
Participant Medical Information
Primary Physician: ____________________________________________________________________
Phone Number: ______________________________________________________________________
Medical Insurance Company: ____________________________________________________________
Policy/Group Number: _________________________________________________________________
PLEASE NOTE
Completing this form is voluntary. It will be referred to ONLY in case of a critical injury or emergency situation. In
the instance that you are unable to provide medical information to an attending physician or hospital, we would
be able to provide it for you with your consent by signing below.
Signature: _________________________________________________ Date: ____________________
Print Name: __________________________________________________________________________
Page 7 of 13
REVISED SEPT. 2014
BETTY’S HOPE ARCHAEOLOGICAL &
BIOARCHAEOLOGICAL FIELD SCHOOL ANTIGUA, SUMMER 2015
FOREIGN TRAVEL INSURANCE PROGRAM ACKNOWLEDGEMENT
Please read the following carefully before signing below:
1. You are required to be covered by Foreign Travel Insurance Program offered through the Office of Risk
Management for the time you will be studying abroad. This coverage is provided as part of your course
fees paid to Regional & Continuing Education at the time of registration.
2. Do NOT discontinue your private health insurance while you are abroad, as it is not always easy to
reenroll upon return to the U.S.
3. If you are going to continue your stay after the program ends, it is strongly recommended that you
continue enrollment in the Foreign Travel Insurance Program. If you anticipate extending your stay
beyond the program end date, be sure to contact the Office of Risk Management to discuss extending
your coverage.
4. Any emergency situation including any injury or illness incurred abroad MUST BE REPORTED
IMMEDIATELY to the number found on the Travel Assistance Card provided by the California State
University Foreign Travel Liability Insurance Program. This insurance program will not cover pre-existing
illnesses or injuries.
5. Only laptops loaded with the typical Microsoft Office suite or similar commercially available software
should be taken out of the United States.
______________________________________________________________________
By signing below, I indicate that I have read and understood the above information, and that I agree to be
covered by Foreign Travel Insurance Program for the duration of my study abroad program. My signature below
also indicates that I understand that it is my responsibility to ensure that I am covered by medical insurance
while traveling after the program has ended.
________________________________________________
Name
________________________________
Chico State ID Number
________________________________________________
Date of Birth
________________________________
Country of Citizenship
________________________________________________
Signature
________________________________
Date
Page 8 of 13
REVISED SEPT. 2014
BETTY’S HOPE ARCHAEOLOGICAL &
BIOARCHAEOLOGICAL FIELD SCHOOL ANTIGUA, SUMMER 2015
AUTHORIZATION FOR RELEASE OF INFORMATION
Consent to disclose information to a parent, guardian, or other trusted person(s).
I, __________________________________________ , give my consent for the Program Director and the
staff of CSU, Chico and Regional and Continuing Education to release any information for the purpose of
discussing any matters pertaining to my student status and situation while I reside overseas to the following
person/people:
(Only one person is necessary; however, you may name two if you wish.)
Name: _______________________________________________________
Relationship: __________________________________________________
Phone Numbers: _______________________________________________
Primary: _________________________________________________________
Secondary: _______________________________________________________
Address:
________________________________________________
________________________________________________
Name:
________________________________________________
Relationship:
________________________________________________
Phone Numbers: _______________________________________________
Primary: _________________________________________________________
Secondary: _______________________________________________________
Address:
________________________________________________
This authorization is valid 6/20/2015-7/18/2015.
Any information shared with the individual(s) authorized to receive information is confidential and may not be shared
with a third party.
Signature: _________________________________________________ Date: ____________________
Print Name: __________________________________________________________________________
Chico State ID Number: ________________________________________________________________
Page 9 of 13
REVISED SEPT. 2014
BETTY’S HOPE ARCHAEOLOGICAL &
BIOARCHAEOLOGICAL FIELD SCHOOL ANTIGUA, SUMMER 2015
California State University, Chico
Chico, California 95929-0130
Summer 2015
Dear Participant:
You are applying to participate in a California State University-affiliated program which requires
air and/or ground transportation.
Air and ground travel involves risks and could result in damage to property, injury to persons,
and death. Please be informed that the California State University assumes no liability for
damage, injury, and death which may occur during air and/or ground travel required by the
California State University-affiliated programs. Your participation in the program is voluntary,
and you participate at your own risk.
Prior to undertaking a California State University-affiliated air and/or ground travel, you are
required to sign a “Release of Liability, Promise Not to Sue, Assumption of Risk and Agreement
to Pay Claims.” Please review the statement carefully before signing it.
Sincerely,
Risk Management
CSU, Chico
530 898-6588
Page 10 of 13
REVISED SEPT. 2014
BETTY’S HOPE ARCHAEOLOGICAL &
BIOARCHAEOLOGICAL FIELD SCHOOL ANTIGUA, SUMMER 2015
RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF
RISK AND AGREEMENT TO PAY CLAIMS
Activity:
Activity Dates:
Activity Location:
Betty’s Hope Antigua Field School Summer 2015: Antigua
June 20 through July 18, 2015
Betty’s Hope Antigua
In consideration for being allowed to participate in this Activity, on behalf of myself and my next of kin, heirs and
representatives, I release from all liability and promise not to sue the State of California; the Trustees of The
California State University; California State University, Chico; CSU, Chico Research Foundation; University
Foundation; and their employees, officers, directors, volunteers, and agents (collectively “University”) from any
and all claims, including claims of the University’s negligence, resulting in any physical or psychological injury
(including paralysis and death), illness, damages, or economic or emotional loss I may suffer because of my
participation in this Activity, including travel to, from and during the Activity.
I am voluntarily participating in this Activity. I am aware of the risks associated with traveling to, from and
participating in this Activity, which include but are not limited to physical or psychological injury, pain, suffering,
illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss,
and/or death. I understand that these injuries or outcomes may arise from my own or other’s actions, inaction,
or negligence; conditions related to travel; or the condition of the Activity location(s). Nonetheless, I assume all
related risks, both known or unknown to me, of my participation in this Activity, including travel to, from and
during the Activity.
I agree to hold the University harmless from any and all claims, including attorney’s fees or damage to my
personal property that may occur as a result of my participation in this Activity, including travel to, from and
during the Activity. If the University incurs any of these types of expenses, I agree to reimburse the University.
If I need medical treatment, I agree to be financially responsible for any costs incurred as a result of such
treatment. I am aware and understand that I should carry my own health insurance.
I am 18 years or older. I understand the legal consequences of signing this document, including (a) releasing
the University from all liability, (b) promising not to sue the University, (c) and assuming all risks of
participating in this Activity, including travel to, from and during the Activity.
I understand that this document is written to be as broad and inclusive as legally permitted by the State of
California. I agree that if any portion is held invalid or unenforceable, I will continue to be bound by the
remaining terms.
I have read this document, and I am signing it freely. No other representations concerning the legal effect of
this document have been made to me.
Signature: _________________________________________________ Date: ____________________
Print Name: __________________________________________________________________________
If Participant is under 18 years of age, also see next page.
Page 11 of 13
REVISED SEPT. 2014
BETTY’S HOPE ARCHAEOLOGICAL &
BIOARCHAEOLOGICAL FIELD SCHOOL ANTIGUA, SUMMER 2015
If Participant is under 18 years of age:
I am the parent or legal guardian of the Participant. I understand the legal consequences of signing this
document, including (a) releasing the University from all liability on my and the Participant’s behalf, (b)
promising not to sue on my and the Participant’s behalf, (c) and assuming all risks of the Participant’s
participation in this Activity, including travel to, from and during the Activity. I allow Participant to participate
in this Activity. I understand that I am responsible for the obligations and acts of Participant as described in this
document. I agree to be bound by the terms of this document.
I have read this two-page document, and I am signing it freely. No other representations concerning the legal
effect of this document have been made to me.
_________________________________________________________________________________
Signature of Minor Participant’s Parent/Guardian
___________________________________________________ ____________________________
Name of Minor Participant’s Parent/Guardian (print)
Date
_________________________________________________________________________________
Minor Participant’s Name
Page 12 of 13
REVISED SEPT. 2014
BETTY’S HOPE ARCHAEOLOGICAL &
BIOARCHAEOLOGICAL FIELD SCHOOL ANTIGUA, SUMMER 2015
CSU, CHICO FACULTY-LED STUDY ABROAD:
STUDENT CODE OF CONDUCT AGREEMENT
Students who participate in CSU, Chico’s faculty-led study abroad programs are subject to all of the same rules
and regulations required of them at CSU, Chico while abroad. Participation in a Chico State study abroad
program is a privilege and not a right. Students who study abroad are considered representatives of CSU, Chico
and “cultural ambassadors” of the state of California and the United States of America. All CSU, Chico students
studying abroad are expected to represent themselves, their campus, and their country with dignity and pride
and to respect the rules, regulations, and laws of the host university and the host country, as well as the rights
and responsibilities afforded Chico students.
I understand that while I am participating in a faculty-led study abroad program, I am considered a current
student at CSU, Chico and will be held accountable for any violations on my part of the Code of Student
Rights and Responsibilities and Title V, California Code of Regulations,
http://www.csuchico.edu/sjd/discipline/studentRights.html and that any violation of this code will be
reported immediately to the Office of Student Judicial Affairs.
In addition, I am bound by the rules and regulations set forth by the program hosts and the laws of the host
country. I waive and release all claims against the University and/or program hosts that arise at a time when
I am not under the direct supervision of the University and/or program hosts or that are caused by my
failure to remain under such supervision or to comply with such rules, standards, and instructions.
I also acknowledge and understand that campus officials acting on behalf of CSU, Chico and/or the program
hosts reserve the right to decline to retain me in the Program at any time should my actions or general
behavior on or off campus, in the sole discretion of the University and/or the program hosts, be determined
to impede or obstruct the progress of the Program in any way.
Signature: _________________________________________________ Date: ____________________
Print Name: __________________________________________________________________________
Page 13 of 13
REVISED SEPT. 2014